Toxic Megacolon – the Complication of an Infection with Clostridium difficile after an Odontogenic Abscess. Case Presentation

Nicolae Suciu 1 , Zalán Benedek 1 , Sorin Sorlea 1 , and Marius Florin Coroș 1
  • 1 Department of Surgery, University of Medicine Pharmacy, Science and Technology, Târgu Mureș, Romania

Abstract

Background:Clostridium difficile (CD) is the major cause of nosocomial antibiotic-associated infections, having as main manifestation diarrhea and life-threatening inflammation of the colon. Surgery may be necessary in up to 80% of patients due to the frequent complications associated with this condition. The mortality rate of this devastating disease could reach 50% even after proper treatment.

Case report: We report a case of a 24-year-old female who was admitted with clinical signs of an odontal inflammatory process. After repeated surgical treatments and antibiotic therapy, she presented acute abdominal pain on the 14th postoperative day. The explorative laparotomy was negative. Clostridium difficile was isolated from her stool, and she was transferred to the Department of Infectious Diseases. After a few days without any favorable clinical outcome, she was transferred to the intensive care unit (ICU), where she developed acute respiratory distress syndrome. Despite the immediate surgical intervention and ICU care, she died within 15 days after admission.

Conclusions: CD infection is considered a complication of antibiotic treatment, having as main cause the combination of fluoroquinolones with antisecretory drugs. In the first phase, the changes of the colon can be minimal with the manifestation of a false acute surgical abdomen, but toxic colon can develop in evolution, leading to multi-system organ failure and death.

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  • 1. Zhu D, Sorg JA, Sun X. Clostridioides difficile Biology: Sporulation, Germination, and Corresponding Therapies for C. difficile Infection. Front Cell Infect Microbiol. 2018;8:29.

  • 2. Polage CR, Solnick JV, Cohen SH. Nosocomial Diarrhea: Evaluation and Treatment of Causes Other Than Clostridium difficile. Clin Infect Dis. 2012;55:982-989.

  • 3. McDonald LC, Gerding DN, Johnson S, et al. Clinical Practice Guidelines for Clostridium difficile Infection in Adults and Children: 2017 Update by the Infectious Diseases Society of America (IDSA) and Society for Healthcare Epidemiology of America (SHEA). Clin Infect Dis. 2018;67:1-48.

  • 4. Hu MY, Katchar K, Kyne L, et al. Prospective derivation and validation of a clinical prediction rule for recurrent Clostridium difficile infection. Gastroenterology. 2019;136:1206-1214.

  • 5. Gupta SB, Mehta V, Dubberke ER. Antibodies to Toxin B Are Protective Against Clostridium difficile Infection Recurrence. Clin Infect Dis. 2016;63:730-734.

  • 6. Bagdasarian N, Rao K, Malani PN, et al. Diagnosis and treatment of Clostridium difficile in adults: a systematic review. JAMA. 2015;313:398-408.

  • 7. Wanahita A, Goldsmith EA, Marino BJ, et al. Clostridium difficile infection in patients with unexplained leukocytosis. M J Med. 2003;115:543.

  • 8. Gerding DN, Muto CA, Owens RC Jr. Treatment of Clostridium difficile Infection. Clinical Infectious Diseases. 2008;46:32-42.

  • 9. Lessa FC, Mu Y, Bamberg WM, et al. Burden of Clostridium difficile Infection in the United States. N Engl J Med. 2015;372:825-834.

  • 10. Lee HC, Kim KO, Jeong YH, et al. Clinical Outcomes in Hospitalized Patients with Clostridium difficile Infection by Age Group. Korean J Gastroenterol. 2016;67:81-86.

  • 11. Oyaro MO, Plants-Paris K, Bishoff D, et al. High rate of Clostridium difficile among young adults presenting with diarrhea at two hospitals in Kenya. International Journal of Infectious Diseases. 2018;74:24-28.

  • 12. See I, Mu Y, Cohen J, et al. AP1 strain type predicts outcomes from Clostridium difficile infection. Clin Infect Dis. 2014;58:1394-1400.

  • 13. Hall AJ, Curns AT, McDonald LC, et al. The roles of Clostridium difficile and norovirus among gastroenteritis-associated deaths in the United States, 1999–2007. Clin Infect Dis. 2012;55:216-223.

  • 14. Stevens VW, Nelson RE, Schwab-Daugherty EM, et al. Comparative Effectiveness of Vancomycin and Metronidazole for the Prevention of Recurrence and Death in Patients With Clostridium difficile Infection. JAMA. 2017;117:546-553.

  • 15. Mankal PK, Abed J, Latte-Naor S, Grinspan A, Kotler DP. Fidaxomicin and Fecal Microbiota Transplants for Severe Clostridium difficile Colitis. American Journal of Therapeutics. 2019;26:115-117.

  • 16. Bhangu A, Nepogodiev D, Gupta A, et al. Systematic review and meta-analysis of outcomes following emergency surgery for Clostridium difficile colitis. Br J Surg. 2012;99:1501-1513.

  • 17. Kaiser AM, Hogen R, Bordeianou L, et al. Clostridium Difficile Infection from a Surgical Perspective. J Gastrointest Surg. 2015;19:1363-1377.

  • 18. Ferrada P, Callcut R, Zielinski MD, et al. Loop Ileostomy Vs. Total Colectomy As Surgical Treatment For Clostridium Difficile Associated Disease: An Eastern Association for the Surgery of Trauma Multicenter Trial. J Trauma Acute Care Surg. 2017;83:36-40.

  • 19. Khalil MA, Bhatnagar SR, Feldman L, et al. Development and validation of a clinical risk calculator for mortality after colectomy for fulminant Clostridium difficile colitis. Journal of Trauma and Acute Care Surgery. 2019. [Epub ahead of print]

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